Home Pharmacy practice Recognizing the importance of early referral to palliative care is critical to patient care

Recognizing the importance of early referral to palliative care is critical to patient care


In an interview with Pharmacy hours at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Ajeet Gajra, MD, MBBS, FACP, discussed research that found that using an augmented intelligence-based system can improve the timeliness of referrals to palliative care and palliative care services in community oncology environments.

Can you discuss the importance of timely referrals to hospice and palliative care services?

Ajeet Gajra, MD, MBBS, FACP: Timely referral to palliative care and palliative care approaching end of life is considered a benchmark of quality in oncology. So our own company, ASCO, through its QOPI program, has established that there are ASCO guidelines, NCCN guidelines, on integrating palliative care from the start of treatment patients battling cancer. And what that leads to is a better expectation of, you know, a set of better patient and family expectation levels, number 1. Number 2, it repeatedly avoids traumatic near-end-of-life treatments.

So what we do know is that if patients with advanced cancer receive chemotherapy, radiation therapy, if they have repeat ER visits, hospital admissions, ICU admissions, these are all bad results. These results actually indicate a poor quality of oncology care delivery, and therefore must be avoided at all costs and prevented. Thus, the way to avoid and prevent them is to integrate palliative care from the beginning of the course. And when the time comes, this palliative care can then be transformed into palliative care, if necessary. And I think that’s an essential element. And unfortunately, there’s still, you know, sometimes confusion about equating palliative care with palliative care. And again, I’ll point out that palliative care is just a small segment of palliative care, which is a much broader term in something that has a much longer continuum, and towards the end of that, you know, we use palliative care.

What obstacles stand in the way of such timely referrals for patients with advanced cancer?

Ajeet Gajra, MD, MBBS, FACP: So, I would smash those hurdles into really 3 buckets. So there are obstacles or barriers from the perspective of a patient or, you know, a caregiver. There are barriers from the perspective of the provider or clinician. And then there are barriers that are, you know, system-imposed barriers. So if we’re talking about patients and caregivers first, there’s always this worry that if palliative care isn’t mentioned in the proper context, or how it’s conveyed to them, there’s a fear that my doctor cowardly. So, you know, unfortunately it’s still a widespread thought process. I think through our awareness and patient-centered education, we need to eliminate that and reduce that kind of mentality. I think we need to make it very clear to patients and families that if their clinical team is recommending palliative care, alongside other therapies they’re receiving, the goal is to really help them manage symptoms more effectively and, in fact, to improve the quality of worrying about. And that doesn’t mean that, you know, their cancer care is off.

So I think there is the other side of the coin. So I said, you know, there’s also the clinician or provider aspect. Thus, providers must also believe that palliative care is an essential component of the cancer control continuum. And when integrated early on, we have many studies, you know, the pioneering work came first, in patients with advanced lung cancer, and now it’s been 10 years. And since then, we have many more studies to demonstrate that early integration of palliative care improves outcomes, both in terms of quality of life and perhaps also survival for these patients. So I think we have to do it.

In other work Cardinal Health has done with community oncology clinicians, there is still a deficit where people don’t integrate palliative care early on. They wait, you know, for very late stages and near the end of life before starting such care. And so it’s still clinicians and providers, perhaps specialized in a community setting. And, you know, the United States is a big country and there are many practices, and especially in rural areas where they are busy practices and these clinicians are busy taking care of all kinds of cancer patients and so maybe it’s not great spirit for them. Education therefore seems essential.

And the third, as I said, is a systemic problem. Do we have enough palliative care providers? You know, it doesn’t have to be doctors, it can be advanced practice providers. It can be a team, you know, that includes an APP and the social worker and other components. But it must be recognized that it is an essential part of patient care.